Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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An Evidence-Based Conversation Between Ken Harvey, Gerald Quigley and Neil Johnston

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

Editor’s Note:
I recently received an email from Dr Ken Harvey the well-known academic from Latrobe University, who is trying to reform some aspects of the TGA, particularly in relation as to how drugs and complementary medicines are registered, and the quality of evidence used to support claims of efficacy.
It’s a subject that has gained traction since the beginning of the year, and there are a range of viewpoints that need to be sorted out so that coherent policies can be formulated that would be broadly supported by all health professionals (not just mainstream health professionals).
About the same time I received a communication from Gerald Quigley talking about the clinical and educational resources that exist within the Society of Hospital Pharmacists of Australia.
I reflected on both these communications and decided to publish them in a positive fashion, hopefully to create an ethical and clinical direction for community pharmacy.

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Ken Harvey is highlighting the problem that the Pharmacy Guild of Australia ignited by not thinking through a proposal for a clinical promotion in conjunction with Blackmore’s Laboratories that involved the blanket recommendation of certain nutritional supplements with particular drugs prescribed for patients.
The PGA was heading in a suitable direction, but the method could not be considered ethical.
i2P offered comment at that time (even sympathy for the PGA which was unusual for us!).

Ken has unearthed a community pharmacy that seems to be following the original PGA promotional method, a method that has been universally condemned.

What was needed (and still is) was a pharmacist qualified in clinical nutrition responding to a patient request and taking a full history of all circumstances. Preferably, this pharmacist should have a degree of “arms-length” from the pharmacy owner, but that is not an absolute necessity.
After a full investigation of the patient’s circumstances and a need is found for nutritional supplements, then a recommendation can be ethically made.

In Ken’s actual experience, this service was being provided by an unqualified sales person in the manner of “would you like coke and fries with that?”


It has often been suggested by i2P that a range of pharmacist health practitioners specialising in lifestyle disorders should be available as a standard primary care service in a clinical setting. Some pharmacies have experimented with nurses in a pharmacy clinical setting, but as yet have not supported qualified pharmacists in this role.

Why not?
It’s a long overdue development. Otherwise we are likely to see more unsuitable equivalents being provided, similar to that uncovered by Ken Harvey.

What follows is Ken’s letter to i2P and following on from that are comments by Gerald Quigley for professional service pharmacists to take on board.

Dear Neil

Yesterday (May 1, 2012) I went to the Hawthorn Pharmore Pharmacy to get a repeat prescription of my wife’s simvastatin ‘script dispensed.   
I was intrigued when a young female sales assistant recommended that BioCeuticals coenzyme Q10 should be purchased with the ‘script and provided a handout (as illustrated).

She had a very convincing and clearly well-scripted sales talk; does your wife lack energy or have sore muscles? Did you know that "statins" decrease Co Q10 levels? Did you know that your heart needs this important supplement if you are taking "statins"?

I was unkind enough to point out that this issue of “companion sales” had produced a lot of adverse publicity for pharmacy,

And the NPS and The Age/Ken Harvey) had evaluated the evidence and were not convinced, She said she knew nothing of this.

So I returned with the NPS and additional literature and asked for the pharmacist-in-charge to make contact. Regrettably, this has yet to happen. 

I remain most disappointed by this pharmacy-consumer interaction.

Sincerely,

Ken

Dr Ken Harvey, Adjunct Associate Professor, School of Public Health, LaTrobe University http://medreach.com.au VOIP (03) 90293697 | Mobile +614 1918 1910 | Fax: +613 9818 1875

Postscript
: Subsequently a pharmacist from Pharmore Pharmacies did respond to my concerns and I took up her offer to make contact by telephone. She mentioned that Pharmore sales assistants had been trained by BioCeuticals which Pharmore believed was a reputable company and she felt the NPS advice was merely one opinion amongst others that she referenced.

Gerald Quigley’s comments follow and we would welcome reader comments as to how we might aggregate all input into a useful format to encourage community pharmacists to deliver optimum professional services.

Hi Neil,

For your consideration please:I have discovered a superb new educational resource!It’s called “Pharmacy Practice and Research” or “The Official Journal of the Society of Hospital Pharmacists of Australia”
And what a monthly read it is!!

I’ve never actually worked in a hospital pharmacy, and my exposure to that area of practice has been limited to ensuring that patients of mine could safely make the transition from the ward to their own home. This common issue is sometimes very challenging for a variety of reasons.On joining SHPA, I was seeking re-stimulation of my “illness” education, because my focus is on “wellness” education.
And I haven’t been disappointed at all.

I was supplied with four back issues of this Journal, and I’m astounded at the relevance of many of the articles to our roles in community Pharmacy.
If you want value for your educational and information dollar, I can’t recommend these journals more highly.

I’ve discovered things that other organizations don’t tell me.
I’ve learned about the issues of being admitted to hospital on a weekend.

I’ve discovered what a “Lipid Pharmacist” is, and their role in running a lipid clinic. What possibilities does that open up in service based pharmacies?
Perhaps new opportunities and new clinical practice.

And why not include a “nutrition” pharmacist, reviewing medicines and nutrient depletions?
In a rather frightening article, I read about unanswered health-related questions in community Pharmacy. Scary stuff, when you consider that we feel that we are doing the best by our patients. This is evidence based material clearly showing that we aren’t!

Or the impact on direct-to-consumer advertising of prescription medicines on the internet?
What ramifications might that have?

Is SHPA a hidden gem? Might be and worth considering for any professional pharmacy practitioner.

I have some comments on Ken Harvey’s exchange at the Pharmore Pharmacy. The Pharmore group I might add take their professional role very, very seriously, and in many instances are well in front of others in patient care.

At The International Science of Nutrition in Medicine and Healthcare Conference in Melbourne (where I chatted to Ken, and was attended by my count, THREE pharmacists), key research was given that “statins” deplete CoQ10, thereby affecting cognition.
GP questioning after that session showed naivety, but a real willingness to understand and advise. In other words, “to take responsibility”.

So do we pharmacists take responsibility or not? Do we have the balls? Or do we just hide behind “the evidence”. Well here’s evidence! But do we need a bit, some, lots or from what source before we accept and apply the results??
Or is it evidence that has to pass some other authority for a tick of approval before we act?
Are we very, very selective in what evidence we are happy with?

The process at the pharmacy in question was great, but far too aligned to “coke and fries”. The product concerned was BioCeuticals brand of CoQ10, “a practitioner only” product!
So where was the pharmacist who simply doesn’t understand what a ‘practitioner only’ product actually entails?? No doubt doing his low-margin, rapid turnaround dispensing with the resultant minimal “supply” fee!

It’s like my “bacon and egg comparison”. We can be involved or committed. In bacon and eggs, the chook is involved, but the pig is committed!

If I was started on a statin, and I was over 50, and I wasn’t given information from the pharmacist as to the potential effects of a statin on cognition, I’d be really annoyed. In fact, if my cognitive abilities decreased, and I wasn’t advised, and the pharmacist might reasonably be expected to know, might that be a reason to seek to speak to a legal advisor?  

Cheers Neil,

Regards,

Gerald

Editor summary:

1. All parties to this conversation appear to be in agreement that the process at the Pharmore Pharmacy was not appropriate.

2. Excluding Ken Harvey, we also agree that the Pharmore group is a highly professional operation that appears to have slipped up on this occasion. Hopefully it is only a “one-off” incident.

3. Everybody has a notion of what constitutes “evidence”. In the case of official Pharmacy, nobody seems to argue a case for the evidence they are prepared to take responsibility for.
It certainly was confused in respect of the PGA/Blackmore’s issue.
It is a base that is definitely wider than promoted mainstream medical evidence – and even that differs according to which branch of medicine is involved.

4. i2P would even go one step further and claim that even when legitimate evidence is available to support the claims for coenzyme Q10, mainstream medicine practitioners simply ignore it, because they lack the experience to make a judgement for this type of treatment or are irrationally and strongly biased against any form of complementary medicine.
Further, i2P have uncovered reported incidence of fraudulent mainstream evidence that has caused us to rely more on our own clinical experience, rather than “toe” a mainstream medical party-line.

5. Pending clarification of legal issues, at least two of us agree that a patient may have an action against a pharmacist, if cognitive difficulties resulted from taking a prescribed “statin” without accompanying information and advice from that pharmacist regarding the use of coenzyme Q10.

Obviously, the evidence debate still has a long way to go before satisfaction sets in.
In conclusion, Gerald Quigley forwarded a comment that recently appeared in the March 2012 edition of the ACNEM Journal a GP reports:

“Throughout medical school, I was a big fan of evidence-based medicine, and I thought it was so convenient that almost everything a doctor needs to know is neatly summarized in the Australian Medicines Handbook and Therapeutic Guidelines.

Setting out to train in General Practice as I was I thought “what could possibly go wrong? The best available evidence is right there at my fingertips”.

How naïve was I? I soon discovered that clinical practice was more of an art than a science, and that evidence was much more than gaining confidence in one’s own clinical experience. Lowe and Brewster (2003. Evidence-based medicine and clinical practice. Journal of Paediatrics and Child Health. Vol 39, Issue 2 pp 145-146) point out that evidence is a synthesis of others’ experience with one’s own ie that the RCTs say in relation to one’s own clinical experience.

More often than not it is the combination of nutrients/anti-oxidants/doctor-patient interactions etc which make a treatment work, and this seldom equates to a double-blind RCT proving the effectiveness of single isolated factors."

That statement reflects the editor's personal belief, and I hope other pharmacists can rally behind that message and include it as part of their own perspective.

Return to home

Submitted by Anonymous on Mon, 18/06/2012 - 15:16.

“Excluding Ken Harvey, we also agree that the Pharmore group is a highly professional operation that appears to have slipped up on this occasion. Hopefully it is only a “one-off” incident.”

I would like to put my 2 cents in as a former Pharmore employee. I now left – so maybe some things have changed.

Pharmore had a number of policies while I was there regarding “companion sales”, as do many other pharmacy chains. Each member of the staff were given “targets” which they must reach each week – this basically a money target. If you reach your target you get a black (or red; I forget which) sticker against your name, below a red (or black) sticker, and above you get a GOLD STAR for all the staff to see. If you get a gold star average for the month you receive a monetary reward. Congratulations. If you don’t reach your targets, the whole staff will know about it. Shame on you.

If staff members do not reach their targets they were given training on how to sell products (approaching customers, etc…) and if that fails, you may get a warning.

Staff were also told to “up sale” – if the customer (and I use this word deliberately) wants a small pack of ibuprofen, talk them into getting the bigger one. That’s better; right?

There were also monthly targets for the whole store called “bombs” – you have to sell a given amount of a product line for that month. For example, one month we had to sell a certain amount of Neurofen, another we had to sell, you guessed it, co-enzyme Q10. If the store meets their store bombs target again they receive a monetary reward that the store can use towards their Christmas party, or washing windows, etc…

I agree that in some cases it is appropriate to recommend proven products to patients, it is part of our primary care job; for instance an emollient and soap-free wash for patients with dermatitis, or spacers for patients with asthma. However, what is happening at Pharmore and other pharmacy chains is completely different. Not only is it against AHPRA guidelines, but it is completely unethical.

Shop staff, although they have some basic training regarding pharmacy medications, will be more swayed by the managers tell them “YOU MUST SELL X” than any basic training they may have had. They are so swayed that I have had some shop staff recommend a "bombs" product to a patient when I had explicitly said it was not appropriate.

Dispensary staff were pressured also; and I’m 100% sure that a pharmacist cannot be told how to practice, and yet they are.

Giving monetary rewards for “selling” brings in a huge conflict of interest for staff members, as they can easily become more interested in selling products rather than looking out for patient interests.

As a pharmacist, I found this type of thing extremely difficult to reconcile with.

Unfortunately, this practice is wide spread in many pharmacies especially large chains. Due to money constraints pharmacies are almost forced to do anything to make ends meet.

However it can be done without this nonsense. I now work in a pharmacy where we are not forced to companion sale. Our prices might be higher, but that pays to have enough pharmacists and shop staff on hand at all times. And it means that we are not forced into unethical money making strategies employed elsewhere.

I believe that the Pharmacy Board and Guild need to work together to help stop these practices, but also make ethical practice profitable for pharmacy owners.

Submitted by Dr Ken Harvey on Mon, 14/05/2012 - 11:17.

Gerald Quigley said, "At The International Science of Nutrition in Medicine and Healthcare Conference in Melbourne, key research was given that “statins” deplete CoQ10, thereby affecting cognition. If I was started on a statin, and I was over 50, and I wasn’t given information from the pharmacist as to the potential effects of a statin on cognition, I’d be really annoyed".

The paper Gerald referred to was titled, "Statins, CoQ10 and cognition, are they related?"
In a study of 340 adults the Swinburne University author noted
(a) their findings indicated there MAY (my emphasis) be subtle cognitive defects in statin users;
(b) it is not known whether statin related cognitive impairments could be due to reduced CoQ10 levels caused by statins and (c) a trial is underway to assess whether there were any cognitive benefits of giving CoQ10 to statin users.
Other recent research (not cited by the above author) has concluded:

"Statin use and type were marginally associated with cognitive impairment. After adjusting for known variables that affect cognition, no association was observed. No regional differences were observed. This large study (24 595 participants (7191 statin users and 17 404 nonusers) found no evidence to support an association between statins and cognitive performance." http://www.ncbi.nlm.nih.gov/pubmed/20513066

"Despite several reports of statin-associated cognitive impairment, this adverse effect remains a rare occurrence among the totality of the literature. If statin-associated cognitive impairment is suspected, a trial discontinuation can reveal a temporal relationship. Switching from lipophilic to hydrophilic statins may resolve cognitive impairment. The vascular benefits and putative cognitive benefits outweigh the risk of cognitive impairment associated with statin use; therefore, the current evidence does not support changing practice with respect to statin use, given this adverse effect" http://www.theannals.com/content/46/4/549.abstract .

In conclusion, NEVER regard conference presentations of unpublished work as definitive; always check the literature before making recommendations.

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